The prevalence of HIV infection in pregnant women is still on the rise despite existing preventive programmes aimed at reducing HIV-transmission. Voluntary counselling and testing during pregnancy is the key entry point in the prevention of mother-to-child transmission (Department of Health, 2000:16; Birdsall et al. 2004:3). Women are often diagnosed as being HIV-positive for the first time when they attend antenatal clinics and consent to HIV testing (UNAIDS, 1997). The objective of this study was to determine the pregnant women's experiences of voluntary counselling and testing (VCT) and to explore and describe the impeding and facilitating factors that played a role in their choice whether or not to consent to HIV testing after having received pre-test counselling. By understanding the impeding and facilitating factors that play a role in the pregnant woman's choice to undergo HIV testing, recommendations could be made to possibly improve the uptake of HIV testing among pregnant women. The population studied in this research consisted of pregnant women making use of antenatal clinics in the Potchefstroom sub-district. Purposive sampling was used to select participants with the assistance of mediators who were working in the local clinics and the hospital. The sample size was determined by data saturation, which was reached after 10 interviews. A qualitative design was used and data was collected by means of semi-structured interviews. Data analysis was carried out simultaneously with data collection. In consensus discussions, the researcher and the co-coder reached consensus on the main and sub-themes. The main themes are the facilitating and impeding factors that play a role in the pregnant women's choice to undergo HIV testing. Based on findings, it was concluded that facilitating and impeding factors that play a role in the pregnant woman's choice to HIV testing do indeed exist. Impeding factors identified were: fear of a positive status; fear of stigmatization and discrimination; fear of lack of support; lack of opportunity to consider their choice to undergo HIV testing; lack of trust that confidentiality will indeed be honoured; fear of knowing possible positive HIV-status that can lead to feelings of depression and mental anguish; differences between counsellors' and pregnant women's characteristics. Facilitating factors consist of the desire to be aware of own HIV status; desire to protect the baby; sufficient information and the importance of trust and confidentiality. Recommendations were subsequently made to make HIV counselling and testing services to pregnant women more user-friendly in order to facilitate the pregnant woman in her choice concerning HIV-testing. Heeding these recommendations will possibly lead to more pregnant women's HIV status being known by the time they go into labour. Recommendations were made that pregnant women be counselled for HIV testing during their first antenatal visit and the HIV-testing being offered to them during the second visit. Research findings reveal that most pregnant women need time to consider their choice to undergo HIV testing and to prepare themselves for the test. Most pregnant women felt that they would possibly consent to HIV testing during their second antenatal visit. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2008.

The prevalence of HIV infection in pregnant women is still on the rise despite existing preventive programmes aimed at reducing HIV-transmission. Voluntary counselling and testing during pregnancy is the key entry point in the prevention of mother-to-child transmission (Department of Health, 2000:16; Birdsall et al. 2004:3). Women are often diagnosed as being HIV-positive for the first time when they attend antenatal clinics and consent to HIV testing (UNAIDS, 1997). The objective of this study was to determine the pregnant women's experiences of voluntary counselling and testing (VCT) and to explore and describe the impeding and facilitating factors that played a role in their choice whether or not to consent to HIV testing after having received pre-test counselling. By understanding the impeding and facilitating factors that play a role in the pregnant woman's choice to undergo HIV testing, recommendations could be made to possibly improve the uptake of HIV testing among pregnant women. The population studied in this research consisted of pregnant women making use of antenatal clinics in the Potchefstroom sub-district. Purposive sampling was used to select participants with the assistance of mediators who were working in the local clinics and the hospital. The sample size was determined by data saturation, which was reached after 10 interviews. A qualitative design was used and data was collected by means of semi-structured interviews. Data analysis was carried out simultaneously with data collection. In consensus discussions, the researcher and the co-coder reached consensus on the main and sub-themes. The main themes are the facilitating and impeding factors that play a role in the pregnant women's choice to undergo HIV testing. Based on findings, it was concluded that facilitating and impeding factors that play a role in the pregnant woman's choice to HIV testing do indeed exist. Impeding factors identified were: fear of a positive status; fear of stigmatization and discrimination; fear of lack of support; lack of opportunity to consider their choice to undergo HIV testing; lack of trust that confidentiality will indeed be honoured; fear of knowing possible positive HIV-status that can lead to feelings of depression and mental anguish; differences between counsellors' and pregnant women's characteristics. Facilitating factors consist of the desire to be aware of own HIV status; desire to protect the baby; sufficient information and the importance of trust and confidentiality. Recommendations were subsequently made to make HIV counselling and testing services to pregnant women more user-friendly in order to facilitate the pregnant woman in her choice concerning HIV-testing. Heeding these recommendations will possibly lead to more pregnant women's HIV status being known by the time they go into labour. Recommendations were made that pregnant women be counselled for HIV testing during their first antenatal visit and the HIV-testing being offered to them during the second visit. Research findings reveal that most pregnant women need time to consider their choice to undergo HIV testing and to prepare themselves for the test. Most pregnant women felt that they would possibly consent to HIV testing during their second antenatal visit. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2008.

Problématique : Implanté en 2004 au Bénin, le programme national de prévention de la transmission du VIH de la mère à l’enfant (PTME) semble globalement bien implanté. Toutefois une enquête, en 2005, révèle certaines difficultés, particulièrement au niveau de la couverture du programme: seulement 70 à 75 % des femmes enceintes vues en consultations prénatales ont été dépistées et 33 % des 1150 femmes dépistées séropositives ont accouché suivant le protocole de PTME. En outre, d’un site à un autre, on relève une grande variation dans la couverture en termes de dépistage et de suivi des femmes enceintes infectées. Cette faiblesse dans la couverture nous a amené à questionner le contexte organisationnel dans lequel le programme est implanté. Objectif : L’objectif général de cette thèse est d’analyser l'implantation de la PTME au Bénin. Le premier objectif spécifique consiste à identifier et comprendre les enjeux reliés à la façon de rejoindre les femmes enceintes dans le cadre du dépistage. Le second consiste à comprendre le contexte d’implantation et son influence sur la mise en œuvre de la PTME. Méthodologie : Cette recherche évaluative s’appuie sur une étude de cas. Six maternités ont été sélectionnées avec le souhait de représenter les différents contextes d’organisation des services. Les données ont été collectées par observation non participante, entrevues semi-dirigées (n=41) réalisées avec des prestataires de services, analyse documentaire des rapports d’activités des maternités et par questionnaires administrés aux femmes enceintes en consultations prénatales (n=371). Résultats : Le premier article a permis d'apprécier le caractère libre et éclairé du consentement au dépistage. Une majorité des femmes enceintes, suivies dans les centres privés, ont été dépistées sans être effectivement informées de la PTME alors que les femmes fréquentant les autres maternités connaissent mieux les composantes de la PTME. Le caractère volontaire du consentement des femmes est généralement respecté sur tous les sites. Le deuxième article porte sur l'analyse de la qualité du conseil pré-test. Seulement 54% des femmes enceintes ont participé à un conseil en groupe et 80% à un conseil individuel. Dans les centres où sont dispensées des séances d'information de groupe, la qualité est meilleure que dans les centres qui dispensent un conseil individuel exclusif. Le troisième article analyse l'influence du contexte d'implantation sur la mise en œuvre du programme. Parmi les facteurs qui contribuent favorablement à la mise en œuvre on relève la proximité d’un centre de référence et la coordination des activités de PTME dans une zone géographique, la responsabilisation du prestataire dédié à la PTME, la supervision formative régulière accompagnée de séances de discussion collective et l’implication des médiatrices dans la recherche active des perdues de vues. A l’opposé, la responsabilisation des médiatrices pour la réalisation du conseil individuel et du dépistage ne favorise pas une bonne mise en œuvre de la PTME. Conclusion : Nos résultats montrent qu'il est possible de jouer sur l'organisation des services de santé dans le cadre du programme du PTME pour améliorer la façon dont le programme est implanté tant dans les centres privés que publics, sans que cela ne représente un ajout net de ressources. C'est le cas de l’amélioration de la qualité du conseil et du dépistage, de l’implantation du processus interne d’apprentissage organisationnel et de la coordination des services. / Problem: Launched in 2004 in Benin, the national program for prevention of mother-to-child transmission (PMCTC) of HIV appears to have been well implemented. Nevertheless, a 2005 survey revealed certain problems, particularly with respect to the program’s coverage: only 70% to 75% of pregnant women seen in prenatal consultation were screened, and only 33% of the 1,150 women found to be HIV-infected were delivered according to the PMCTC protocol. In addition, there was great variation in coverage from one site to another in terms of screening and of follow-up for infected pregnant women. This inadequate coverage raised questions about the organizational context in which the program is implemented. Objectives: The overall objective of this thesis is to analyze the implementation of the PMTCT program in Benin. The first specific objective is to identify and understand the issues related to how pregnant women are contacted as part of the screening process. The second is to understand the implementation context and its influence on how the PMTCT program is carried out. Methodology: This evaluative research is based on a case study. Six maternity units were selected in order to provide a representative sample of the different service organization settings. Data were collected through non-participant observation, semi-structured interviews (n=41) with service providers, documentary analysis of the maternity centres’ activity reports, and questionnaires administered to pregnant women at prenatal consultations (n=371). Results: The first article, whose objective was to appreciate the free and informed nature of consent to screening, revealed differences between maternity. A majority of pregnant women followed in private centres were screened without being adequately informed about the PMTCT program, whereas the women in others centres were better informed about the specifics of the program. The voluntary nature of the consent was generally respected. The second article analyzes the quality of the pre-test counselling. Only 54% of the pregnant women in our sample participated in group pre-test counselling sessions and 80% in individual counselling. In centres, which organize group information sessions, the quality is better than in centres, where counselling is provided exclusively to individuals. The third article analyzes the influence of the implementation context on how the program is carried out. Among the factors that contribute positively to implementation are: the proximity of a referral centre and the coordination of PMTCT activities within a geographic area; designating a care provider to oversee the PMTCT program; conducting regular formative supervision with group discussion sessions; and involving mediators—HIV-positive women hired by the program to provide psychological accompaniment—in actively seeking out women who have been lost to follow-up. Conversely, putting mediators in charge of individual counselling or of screening does not foster good implementation of the PMTCT program. Conclusion: Our results show that it is possible to adjust the organization of healthcare services for the PMTCT program in order to improve implementation in both the private and public sectors with no net increase in resources. This is the case for improving the quality of counselling and of screening, the implementation of the internal process of organizational learning, and the coordination of services.

Problématique : Implanté en 2004 au Bénin, le programme national de prévention de la transmission du VIH de la mère à l’enfant (PTME) semble globalement bien implanté. Toutefois une enquête, en 2005, révèle certaines difficultés, particulièrement au niveau de la couverture du programme: seulement 70 à 75 % des femmes enceintes vues en consultations prénatales ont été dépistées et 33 % des 1150 femmes dépistées séropositives ont accouché suivant le protocole de PTME. En outre, d’un site à un autre, on relève une grande variation dans la couverture en termes de dépistage et de suivi des femmes enceintes infectées. Cette faiblesse dans la couverture nous a amené à questionner le contexte organisationnel dans lequel le programme est implanté. Objectif : L’objectif général de cette thèse est d’analyser l'implantation de la PTME au Bénin. Le premier objectif spécifique consiste à identifier et comprendre les enjeux reliés à la façon de rejoindre les femmes enceintes dans le cadre du dépistage. Le second consiste à comprendre le contexte d’implantation et son influence sur la mise en œuvre de la PTME. Méthodologie : Cette recherche évaluative s’appuie sur une étude de cas. Six maternités ont été sélectionnées avec le souhait de représenter les différents contextes d’organisation des services. Les données ont été collectées par observation non participante, entrevues semi-dirigées (n=41) réalisées avec des prestataires de services, analyse documentaire des rapports d’activités des maternités et par questionnaires administrés aux femmes enceintes en consultations prénatales (n=371). Résultats : Le premier article a permis d'apprécier le caractère libre et éclairé du consentement au dépistage. Une majorité des femmes enceintes, suivies dans les centres privés, ont été dépistées sans être effectivement informées de la PTME alors que les femmes fréquentant les autres maternités connaissent mieux les composantes de la PTME. Le caractère volontaire du consentement des femmes est généralement respecté sur tous les sites. Le deuxième article porte sur l'analyse de la qualité du conseil pré-test. Seulement 54% des femmes enceintes ont participé à un conseil en groupe et 80% à un conseil individuel. Dans les centres où sont dispensées des séances d'information de groupe, la qualité est meilleure que dans les centres qui dispensent un conseil individuel exclusif. Le troisième article analyse l'influence du contexte d'implantation sur la mise en œuvre du programme. Parmi les facteurs qui contribuent favorablement à la mise en œuvre on relève la proximité d’un centre de référence et la coordination des activités de PTME dans une zone géographique, la responsabilisation du prestataire dédié à la PTME, la supervision formative régulière accompagnée de séances de discussion collective et l’implication des médiatrices dans la recherche active des perdues de vues. A l’opposé, la responsabilisation des médiatrices pour la réalisation du conseil individuel et du dépistage ne favorise pas une bonne mise en œuvre de la PTME. Conclusion : Nos résultats montrent qu'il est possible de jouer sur l'organisation des services de santé dans le cadre du programme du PTME pour améliorer la façon dont le programme est implanté tant dans les centres privés que publics, sans que cela ne représente un ajout net de ressources. C'est le cas de l’amélioration de la qualité du conseil et du dépistage, de l’implantation du processus interne d’apprentissage organisationnel et de la coordination des services. / Problem: Launched in 2004 in Benin, the national program for prevention of mother-to-child transmission (PMCTC) of HIV appears to have been well implemented. Nevertheless, a 2005 survey revealed certain problems, particularly with respect to the program’s coverage: only 70% to 75% of pregnant women seen in prenatal consultation were screened, and only 33% of the 1,150 women found to be HIV-infected were delivered according to the PMCTC protocol. In addition, there was great variation in coverage from one site to another in terms of screening and of follow-up for infected pregnant women. This inadequate coverage raised questions about the organizational context in which the program is implemented. Objectives: The overall objective of this thesis is to analyze the implementation of the PMTCT program in Benin. The first specific objective is to identify and understand the issues related to how pregnant women are contacted as part of the screening process. The second is to understand the implementation context and its influence on how the PMTCT program is carried out. Methodology: This evaluative research is based on a case study. Six maternity units were selected in order to provide a representative sample of the different service organization settings. Data were collected through non-participant observation, semi-structured interviews (n=41) with service providers, documentary analysis of the maternity centres’ activity reports, and questionnaires administered to pregnant women at prenatal consultations (n=371). Results: The first article, whose objective was to appreciate the free and informed nature of consent to screening, revealed differences between maternity. A majority of pregnant women followed in private centres were screened without being adequately informed about the PMTCT program, whereas the women in others centres were better informed about the specifics of the program. The voluntary nature of the consent was generally respected. The second article analyzes the quality of the pre-test counselling. Only 54% of the pregnant women in our sample participated in group pre-test counselling sessions and 80% in individual counselling. In centres, which organize group information sessions, the quality is better than in centres, where counselling is provided exclusively to individuals. The third article analyzes the influence of the implementation context on how the program is carried out. Among the factors that contribute positively to implementation are: the proximity of a referral centre and the coordination of PMTCT activities within a geographic area; designating a care provider to oversee the PMTCT program; conducting regular formative supervision with group discussion sessions; and involving mediators—HIV-positive women hired by the program to provide psychological accompaniment—in actively seeking out women who have been lost to follow-up. Conversely, putting mediators in charge of individual counselling or of screening does not foster good implementation of the PMTCT program. Conclusion: Our results show that it is possible to adjust the organization of healthcare services for the PMTCT program in order to improve implementation in both the private and public sectors with no net increase in resources. This is the case for improving the quality of counselling and of screening, the implementation of the internal process of organizational learning, and the coordination of services.

This study is concerned with the pre-test counselling conversation (as regulated by policy-governing and training documents) that occurs between HIV counsellors and their clients. It attempts to explore and describe some of the assumptions underlying HIV/AIDS pre-test counselling in South Africa, and reflects on how these assumptions determine the content and process of HIV pre-test counselling. This exploration has been done by means of an analysis of a selection of official and non-official documentation on pre-test counselling. The aim of HIV/AIDS counselling in general is to support and educate infected/affected clients about the HI-virus. Pre-test counselling (the conversation that takes place before an HIV-test is administered) forms the entry level to HIV counselling service delivery in South Africa, and it is often the only opportunity a counsellor has to support and educate a client about HIV/AIDS. Policy-governing pre-test counselling and training documents on such counselling confirm the role played by counsellors. The pre-test counselling conversation is based on the assumption that education about the HI-virus will enable clients to make informed decisions about their health which will help them to live long and healthy lives once they are aware of their HIV-status. However, this educational approach does not seem to be successful, as a change in risk behaviour is often not achieved. My recognition of this situation motivated this study and its focus on the conversation that takes place between counsellors and their clients in pre-test counselling. I was curious about what is discussed during pre-test counselling and why, if we acknowledge that counselling plays a major role in infection rate prevention, risk-reducing behaviour is not being achieved. This qualitative study was based on a social constructionist paradigm and document analysis was used as a research method. This study offers an alternative approach to health education – a drive towards client-centred pre-test counselling where the client’s needs become the focus of the pre-test counselling conversation. / Dissertation (MA (Counselling Psychology))--University of Pretoria, 2007. / Psychology / unrestricted